"Don't Take Us Back"

Just as HIV experts are beginning to see new hope in beating the AIDS epidemic, a funding crisis threatens to throw us back a decade or more in the effort to combat this deadly virus. Dr. Peter Mugyenyi and other HIV experts delivered this forceful message to U.S. lawmakers today at a hearing before the House Foreign Affairs Subcommittee on Africa and Global Health.

Dr. Mugyenyi, director of Uganda’s Joint Clinical Research Center, was one of several witnesses who urged Congress to keep its promise on global AIDS by fully funding PEPFAR, instead of approving the near flat budget proposed by the White House for FY 2011.

Dr. Peter Mugyenyi testifies before a House Foreign Affairs subcommittee

Dr. Mugyenyi said that already, last year’s flat-funding has rippled across his home country of Uganda, forcing him and other health care providers to turn away sick patients who were promised treatment. Dr. Mugyenyi described having to turn away as many as 15 to 20 patients a day, including pregnant and breastfeeding women.

“Recently, an HIV-infected woman who was breastfeeding her HIV-negative child because she could not afford formula milk came to our clinic, having been turned away from three other clinics in Kampala because they had no slots. She knew that every day she breast fed her baby without being on treatment greatly increased the chances of her child getting infected, but she had no alternative,” he said.

The situation, he said, jeopardizes the incredible gains PEPFAR has achieved in its first five years. “PEPFAR has saved millions of lives in Africa,” he said. “These people—and their mothers, husbands, wives and children—got a chance to live” because of PEPFAR. The program has “helped ease the carnage that I and my fellow health care providers used to witness on a daily basis.”

Dr. Mugyenyi pointed to recent studies showing that treatment with antiretroviral drugs can also help prevent new infections. Research released at CROI last month documented a 90 percent reduction in HIV transmission among so-called “discordant couples,” in which one partner is HIV-infected and the other is not.

“This gives credence to recent modeling by the World Health Organization that shows some of the first good news on prevention in several years: that we could truly end the AIDS crisis within a generation,” he said. “However, a funding crisis threatens to reverse these highly positive changes and we could miss the opportunity to defeat the epidemic.”

Rep. Donald Payne, D-N.Y., chairman of the subcommittee, said he was “deeply concerned about the reports that the fight against HIV/AIDS is faltering and that continued rapid roll out of AIDS treatment is endangered in Africa. We must make sure we don’t start a decline.”

The panelists and lawmakers alike commended President Obama’s proposed Global Health Initiative, with its call to spend $63 billion over six years and its promise of an integrated approach to foreign health assistance. But experts testified that the GHI would only work if it was adequately funded

And so far, said Joanne Carter, executive director of the RESULTS Educational Fund, there’s a gap between rhetoric and reality on US global health funding. The White House’s budget request for FY 2011 “essentially flat funds our global AIDS programs,” she said, noting it’s more than $2 billion short of what was promised in the Lantos-Hyde Act that reauthorized PEPFAR.

The White House budget also calls for a $50 million cut to the US contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria. And she noted that the GHI’s treatment targets for TB were significantly lower than mandated in Lantos-Hyde.

PEPFAR has been “nothing short of transformative,” Carter said. “We’ve made remarkable progress, and we can’t stop now.”

Actress Debra Messing, the global AIDS ambassador for Population Services International (PSI), spoke eloquently of a recent trip to Zimbabwe, where she saw HIV testing and prevention services at a PSI clinic. Messing said that key prevention tools, such as male circumcision, need to be scaled up. MC alone “could avert almost 750,000 adult HIV infections and … could yield $3.8 billion in savings between 2009 and 2025,” she said.

Messing also called for more aggressive funding of testing and counseling services, saying “knowledge is power.”

Dr. Mugyenyi offered a powerful closing statement. “This is a critical time for Africa,” he said. “Don’t’ take us back to the dark ages of the 1990s,” when HIV was a death sentence.

He fretted that doctors were now faced with horrible choices, such as giving a pregnant woman a drug to block HIV transmission so her baby can be born free of HIV, but then turning the mother away for full HIV therapy, leaving her to die and her child to be motherless.

“AIDS is unforgiving if action is not taken,” he said. “Things will not become any easier” if the crisis is neglected.